Sequential chemotherapy and radiation for nasopharyngeal cancer: absence of long-term benefit despite a high rate of tumor response to chemotherapy.

Tannock, Ian F.; Payne, David G.; Hewitt, Kelly; Panzarella, Tony

doi:10.1200/jco.1987.5.4.629

Cited by 99 publications

(13 citation statements)

References 12 publications

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“…When response rates for NPC are compared to those obtained in recurrent squamous cell cancer of other head and neck sites, it seems that NPC is more likely to show an objective regression of neoplastic lesions both in our and others experience (Al Sarraf, 1988;Choksi et al, 1988;. A degree of responsiveness higher than that for other head and neck carcinomas has also been reported by some authors in studies dealing with previously untreated patients who received chemotherapy as initial treatment before locoregional therapy (Hill et al, 1986;Clark et al, 1987;Tannock et al, 1987;Bachouchi et al, 1990). However, in our opinion the mean duration of objective response to CDDP-based chemotherapy is far from optimal, and that of responses achieved with second line chemotherapy is dismal.…”

Section: Discussionsupporting

confidence: 69%

Chemotherapeutic treatment of recurrent and/or metastatic nasopharyngeal carcinoma: a retrospective analysis of 40 cases

Gebbia¹,

Zerillo²,

Restivo³

et al. 1993

Br J Cancer

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Initial treatment of nasopharyngeal carcinoma (NPC) generally involves radiotherapy because of the difficulty in performing radical surgery in this area of the head/neck, and because of the good local control achieved with radiotherapy alone (Perez & Brady, 1987;Fee, 1990).Despite the high cure rate for patients with stage I and II NPC, the prognosis of patients with stage III and IV is still disappointing being the 5-year survival rate in the range of 10-45% and 0-30% for stage III and stage IV respectively (Ho, 1978;Huang, 1980;Huang & Chu, 1981).The most frequent cause of death in advanced NPC is represented by loco-regional recurrence, but also distant metastatic spread contributes to further worsen patients' prognosis (Merino et al., 1977;Bedwinek et al., 1980;Vikram et al., 1985). In fact, among carcinomas developing in the head/ neck area, cancers arising in the nasopharynx are those that, by far, most frequently spread to distant organs with an incidence of distant metastases ranging from 20% to 40% (Bedwinek et al., 1980;Vikram et al., 1986).To date there is little information on the role of systemic chemotherapy in the management of patients with recurrent and/or metastatic NPC . Small groups of patients with advanced NPC have been generally enrolled in larger studies including patients with HNC originating from sites other than nasopharynx (Amrein & Weiztman, 1985;Merlano et al., 1987;Choksi et al., 1988;Palmeri et al., 1989;. Thus it is very difficult, if not impossible, to draw any conclusions on the role of chemotherapy in advanced NPC from such studies. Moreover, the clinical characteristics of these patients significantly differ from those of patients affected by other HNC (Fedder, 1985;Perez & Brady, 1987 al., 1980; Vickram et al., 1986;Perez & Brady, 1987).In the present paper we report a review of the outcome of 40 cases of recurrent and/or metastatic NPC treated with cisplatin-containing polychemotherapeutic regimens at our Institution. This retrospective analysis was carried out in view of the current scarcity of medical literature concerning the chemotherapeutic management of metastatic and/or recurrent NPC.Patients and methods All patients included in this review were required to have: histologically confirmed NPC reviewed by a pathologist; recurrent NPC after loco-regional therapy or metastatic disease; bidimensionally measurable disease which included loco-regional recurrencies or distant metastases evaluated by CT scan and/or other diagnostic tools, such as chest X-ray and bone X-ray for pulmonary and bone metastatic deposits respectively, and sonograms for abdominal tumour loads.Between July 1984 and July 1992, 320 patients with histologically proven advanced stage III and IV carcinoma of any site in the head and neck region were seen at the Division of Othorhinolaryngology and at the Service of Chemotherapy of the University of Palermo, Italy. Among these patients, 40 patients with recurrent and/or metastatic NPC responded to the above-mentioned elegibility criteria. These patients ha...

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Section: Discussionsupporting

confidence: 69%

Chemotherapeutic treatment of recurrent and/or metastatic nasopharyngeal carcinoma: a retrospective analysis of 40 cases

Gebbia¹,

Zerillo²,

Restivo³

et al. 1993

Br J Cancer

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“…In the current study, a signi cantly high initial clinical response rate was obtained in 86% of patients with 44% complete responders. This overall response rate following induction CT is comparable to some series (4,10,20,23), but lower than that reported by others (19,21,22). This may re ect differences in administered doses and number of cycles as well as in the chemotherapeutic agents used.…”

Section: Sur×i×al and Disease -Free Inter×alsupporting

confidence: 73%

“…Data accumulated from numerous phase II trials showed that the use of neoadjuvant CT was associated with encouraging response rates ranging from 75 to 98% (19)(20)(21)(22). However, whether the excellent response to CT can be translated into survival bene t has not been determined (23)(24)(25). Several studies that used non-controlled historical data and matched cohort groups provided evidence that induction CT prior to de nitive radiation improves freedom from distant metastases, disease-free survival (DFS) and OS for patients with advanced disease (4,11,26).…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Chemotherapy Plus Conventional Radiotherapy or Accelerated Hyperfractionation in Stage III and IV Nasopharyngeal Carcinoma - A Phase II Study

El-Weshi

2001

Acta Oncologica

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A prospective phase II trial was initiated in previously untreated patients with locally advanced nasopharyngeal carcinoma (NPC). The goal was to achieve improvement in locoregional control, disease-free interval and overall survival using induction chemotherapy and to compare conventional fractionation (CF) with an accelerated hyperfractionation (AHF) regimen. Fifty patients were treated (5 AJCC Stage III, 45 Stage IV) with induction chemotherapy consisting of two cycles of cisplatin and 5-fluorouracil. Patients were then randomized between CF and AHF therapy. A clinical response to induction chemotherapy was reported in 86% of patients prior to radiotherapy (44% complete response, 42% partial response). Patients with complete or major partial responses to induction chemotherapy had a significantly better 5-year overall survival (60%) and disease-free interval (59%) than those with no response or minor partial response (15% and 18% p = 0.009 and 0.0009). Acute radiation reactions were more pronounced in the AHF group (p = 0.0002), and the incidence of late normal tissue injury was more frequent (p = 0.08). At 5 years, the locoregional control rate was higher in the AHF arm (76%) than in the CF group (54%), but the difference was not significant (HR, 0.52; 95%, Cl, 0.15-2.83; p = 0.186). With a median follow-up period of 55 months (range 4-120), the 5-year disease-free interval and overall survival rates were more favorable in the AHF group than in the CF group, but the differences were not significant (59% and 54% vs. 34% and 36%, respectively, HR for disease-free interval = 0.71; 95% CI, 0.27-1.88; p=0.198 and HR for overall survival = 0.81; 95% CI, 0.37-1.78; p=0.433). The overall treatment failure rate was 48%. Locoregional failures occurred in 12 patients (24%) and the incidence of distant metastases reached 30%. Response to induction chemotherapy is strongly predictive for locoregional control, disease-free interval and overall survival. Accelerated hyperfractionation was associated with high incidence of acute and late toxicity without significant improvement in locoregional control rate. The optimal chemotherapy dose and sequencing with radiotherapy needs to be investigated in future studies. Distant metastases remain the main cause of treatment failure in NPC.

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“…Advanced T-stage and lower radiation doses predicted locoregional tumoral failure, whereas advanced N-stage and exclusion of chemotherapy predicted systemic failure. The relatively short time to development of systemic failure, in the absence of locoregional tumoral failure, might indicate the presence of occult systemic disease at the time of diagnosis [27,41,42].…”

Section: Discussionmentioning

confidence: 97%

Nasopharyngeal carcinoma in childhood and adolescence

Serin

Erkal

Elhan

et al. 1998

Med. Pediatr. Oncol.

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Background This study reviews the authors' experience from 1979 through 1996 in the management and outcome of 56 patients with nasopharyngeal carcinoma who were under 20 years of age. Procedure There were 33 males and 23 females, their ages ranging from 7 to 19 years (median: 16 years). Forty patients had World Health Organization type III carcinomas, 16 had T4 tumors, 41 had metastatic cervical lymph nodes, and 50 were at stage III or stage IV. Thirty‐two patients were treated with radiation therapy alone and 24 with the addition of chemotherapy. Cumulative radiation dose to the primary tumor ranged from 18 to 70 Gy (median: 66 Gy) and radiation dose to metastatic cervical lymph nodes ranged from 18 to 70 Gy (median: 66 Gy). Results Follow‐up ranged from 0.1 to 16.8 years (mean: 9 years). Locoregional tumoral complete response was achieved in 49 patients. Locoregional tumoral failure was observed in 12 patients and systemic failure in 11. Overall, locoregional failure‐free, metastases‐free, and disease‐free survival rates at 5 years were 49%, 62%, 79%, and 47%, respectively, for the entire group of patients, 42%, 61%, 72%, and 42%, respectively, for patients treated with radiation therapy alone, and 58%, 63%, 87%, and 54%, respectively, for patients treated with the addition of chemotherapy. Advanced T‐stage and lower radiation doses worsened locoregional failure‐free survival, whereas advanced N‐stage and exclusion of chemotherapy worsened metastases‐free survival. Conclusions In children and adolescents with nasopharyngeal carcinoma, radiation therapy alone results in an improved locoregional tumoral response rate and a reduced locoregional tumoral failure rate at higher radiation doses, while the addition of chemotherapy results in a reduced systemic failure rate. Med. Pediatr. Oncol. 31:498–505, 1998. © 1998 Wiley‐Liss, Inc.

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Sequential chemotherapy and radiation for nasopharyngeal cancer: absence of long-term benefit despite a high rate of tumor response to chemotherapy.

Cited by 99 publications

References 12 publications

Chemotherapeutic treatment of recurrent and/or metastatic nasopharyngeal carcinoma: a retrospective analysis of 40 cases

Chemotherapeutic treatment of recurrent and/or metastatic nasopharyngeal carcinoma: a retrospective analysis of 40 cases

Neoadjuvant Chemotherapy Plus Conventional Radiotherapy or Accelerated Hyperfractionation in Stage III and IV Nasopharyngeal Carcinoma - A Phase II Study

Nasopharyngeal carcinoma in childhood and adolescence

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